NPIMap

Individual provider Active NPI

Mark Carroll Guerdan, D.O.

  • Anesthesiology Physician
  • Riverdale, GA
National Provider Identifier
1326089574
Registry record updated Jul 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
61081 Issued in GA
Practice address
6525 Professional PL
Suite B
Riverdale, GA 30274-2519
Phone
(404) 254-5496
Fax
(404) 254-5829
NPI assigned
Jun 9, 2006
Last updated
Jul 14, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 31403 KY
Anesthesiology Physician 207L00000X 62257 NY
Pain Medicine (Anesthesiology) Physician 207LP2900X 061081 GA
Interventional Pain Medicine Physician 208VP0014X 061081 GA
Anesthesiology Physician 207L00000X 61081 GA Primary
Pain Medicine Physician 208VP0000X 61081 GA
Pain Medicine (Anesthesiology) Physician 207LP2900X 61081 GA

Addresses

Primary practice location

6525 Professional PL
Suite B
Riverdale, GA 30274-2519

Mailing address

6525 Professional PL
Suite B
Riverdale, GA 30274-2519
Phone (404) 254-5496

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
31403KYMDRegistered Nurse
61081GAMDAnesthesiology Physician
62257NYMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Amsol Physicians of Columbus Ga LLC Anesthesiology Past Accepting new patients
Triangle Anesthesia Group PSC Anesthesiology Past Accepting new patients
Hutcheson Anesthesia & Pain Treatment, LLC Anesthesiology Past Accepting new patients
Amsol Physicians of Columbus Ga Anesthesiology Past Accepting new patients
Ashland Anesthesia, P.S.C. Anesthesiology Past Accepting new patients
Ozarks Medical Center Pain Medicine Past Accepting new patients

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405296000000",
    "number": "1326089574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6525 PROFESSIONAL PL",
            "address_2": "SUITE B",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742519",
            "telephone_number": "404-254-5496",
            "fax_number": "404-254-5829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6525 PROFESSIONAL PL",
            "address_2": "SUITE B",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742519",
            "telephone_number": "404-254-5496",
            "fax_number": "404-254-5829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUERDAN",
        "first_name": "MARK",
        "middle_name": "CARROLL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2014-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "KY",
            "license": "31403",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "62257",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "GA",
            "license": "061081",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "GA",
            "license": "061081",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "GA",
            "license": "61081",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "GA",
            "license": "61081",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "GA",
            "license": "61081",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.